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Effect of salt substitution on cardiovascular events and death

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Title: Effect of salt substitution on cardiovascular events and death
Authors: Neal, B
Wu, Y
Feng, X
Zhang, R
Zhang, Y
Shi, J
Zhang, J
Tian, M
Huang, L
Li, Z
Yu, Y
Zhao, Y
Zhou, B
Sun, J
Liu, Y
Yin, X
Hao, Z
Yu, J
Li, K-C
Zhang, X
Duan, P
Wang, F
Ma, B
Shi, W
Di Tanna, GL
Stepien, S
Shan, S
Pearson, S-A
Li, N
Yan, LL
Labarthe, D
Elliott, P
Item Type: Journal Article
Abstract: BACKGROUND Salt substitutes with reduced sodium levels and increased potassium levels have been shown to lower blood pressure, but their effects on cardiovascular and safety outcomes are uncertain. METHODS We conducted an open-label, cluster-randomized trial involving persons from 600 villages in rural China. The participants had a history of stroke or were 60 years of age or older and had high blood pressure. The villages were randomly assigned in a 1:1 ratio to the intervention group, in which the participants used a salt substitute (75% sodium chloride and 25% potassium chloride by mass), or to the control group, in which the participants continued to use regular salt (100% sodium chloride). The primary outcome was stroke, the secondary outcomes were major adverse cardiovascular events and death from any cause, and the safety outcome was clinical hyperkalemia. RESULTS A total of 20,995 persons were enrolled in the trial. The mean age of the participants was 65.4 years, and 49.5% were female, 72.6% had a history of stroke, and 88.4% a history of hypertension. The mean duration of follow-up was 4.74 years. The rate of stroke was lower with the salt substitute than with regular salt (29.14 events vs. 33.65 events per 1000 person-years; rate ratio, 0.86; 95% confidence interval [CI], 0.77 to 0.96; P=0.006), as were the rates of major cardiovascular events (49.09 events vs. 56.29 events per 1000 person-years; rate ratio, 0.87; 95% CI, 0.80 to 0.94; P<0.001) and death (39.28 events vs. 44.61 events per 1000 person-years; rate ratio, 0.88; 95% CI, 0.82 to 0.95; P<0.001). The rate of serious adverse events attributed to hyperkalemia was not significantly higher with the salt substitute than with regular salt (3.35 events vs. 3.30 events per 1000 person-years; rate ratio, 1.04; 95% CI, 0.80 to 1.37; P=0.76). CONCLUSIONS Among persons who had a history of stroke or were 60 years of age or older and had high blood pressure, the rates of stroke, major cardiovascular events, and death from any cause were lower with the salt substitute than with regular salt. (Funded by the National Health and Medical Research Council of Australia; SSaSS ClinicalTrials.gov number, NCT02092090. opens in new tab.)
Issue Date: 16-Sep-2021
Date of Acceptance: 1-Sep-2021
URI: http://hdl.handle.net/10044/1/92012
DOI: 10.1056/NEJMoa2105675
ISSN: 0028-4793
Publisher: Massachusetts Medical Society
Start Page: 1067
End Page: 1077
Journal / Book Title: New England Journal of Medicine
Volume: 385
Issue: 12
Copyright Statement: © 2021 Massachusetts Medical Society. All rights reserved.
Sponsor/Funder: British Heart Foundation
Imperial College Healthcare NHS Trust- BRC Funding
UK DRI Ltd
Health Data Research Uk
Funder's Grant Number: RE/18/4/34215
RDF03
DRI-CORE2020-IMP
Health Data Research UK
Keywords: Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
BLOOD-PRESSURE
DISEASE
SODIUM
POTASSIUM
STROKE
Aged
Cardiovascular Diseases
China
Diet, Sodium-Restricted
Female
Humans
Hyperkalemia
Hypertension
Male
Middle Aged
Mortality
Potassium, Dietary
Secondary Prevention
Stroke
Humans
Cardiovascular Diseases
Hypertension
Hyperkalemia
Potassium, Dietary
Diet, Sodium-Restricted
Mortality
Aged
Middle Aged
China
Female
Male
Stroke
Secondary Prevention
Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
BLOOD-PRESSURE
DISEASE
SODIUM
POTASSIUM
STROKE
General & Internal Medicine
11 Medical and Health Sciences
Publication Status: Published
Online Publication Date: 2021-09-16
Appears in Collections:School of Public Health